Published: May 2003
Palliative Measures for Xerostomia and Pain
There is no one product that has demonstrated complete effectiveness in the relief of xerostomia and pain. A clean, well-hydrated mouth may prevent exacerbation of the complications associated with cancer therapies and may be the most important suggestion for easing these complaints. The following empirical suggestions may be helpful, and an empathetic ear may greatly enhance the patient's comfort.
Measures to Assist the Xerostomic Patient
Dietary Counselling
To aid in swallowing, foods may be softened or thinned with liquids such as skim milk, broth or water. In addition, melted margarine or gravy may be added to foods if fat consumption is not a problem. Foods with some bulk may be easier to swallow than liquids. Dry foods may be dunked in liquids. Alcohol and drinks with caffeine may cause additional dryness. Carbonated beverages with sugar and diet drinks with phosphoric and citric acids should be discouraged.
Saliva Stimulation
The use of a sugarless gum or candy containing xylitol as a sweetening agent or a wax bolus may help stimulate salivary flow. It may also be helpful to keep a cherry pit or small glass bead in the mouth. Sialogogues such as pilocarpine (and anethole trithione, which is available in Canada and Europe) may benefit some patients with residual salivary gland function.
Saliva Substitutes
A trial of a commercial oral lubricant may be suggested for the patient with a dry mouth. Water alone remains a frequently used mouth-wetting agent, although a small amount of glycerine (1/4 tsp) may be added to eight ounces of water to offer longer-lasting relief from dryness.
Palliative Measures for Xerostomia and Pain
Measures for the Palliation of Pain
It is imperative to determine the etiology of pain prior to suggesting palliative measures.
Topical preparation
A variety of topical anesthetic and coating agents are available to palliate painful mucositis.
Analgesics
Systemic analgesics, such as acetaminophen or ibuprofen, may be taken according to product directions. More potent analgesics may be needed.
Dietary counselling
Patients should be aware that irritating foods such as acidic citrus fruits and juices, hot and spicy products and rough-textured foods may cause additional discomfort. Straws may be used to drink liquids. Temporary comfort may be achieved by sucking on ice chips or popsicles. The patient's diet may consist of foods that are easy to chew and swallow such as milk shakes, cooked cereals and scrambled eggs; soft and pureed fruits and vegetables such as apple sauce and mashed potatoes; custards, puddings and gelatins; and high-moisture foods such as sorbets and ices.
Infection control
Early identification and treatment of infections will diminish the severity of mucositis and help control pain.
The following products and practices may increase dryness and pain and should be avoided:
Commercial mouthwashes
Most over-the-counter mouthwashes should not be used because they have a high alcohol content and can dry and irritate the oral tissues. Flavouring and colouring agents also may be irritating. Alcohol-free mouth-washes are available.
Peroxide
Excessive use of hydrogen peroxide 3% and carbamide peroxide 10% are acidic and may be irritating to the oral tissues and disrupt the normal oral flora. When used, hydrogen peroxide 3% should be diluted (one part peroxide to four parts of water or saline) and should be limited to short-term use.
Alcohol and Tobacco Products
Use should be discouraged due to the irritating and carcinogenic effects. Passive smoke may be filtered from rooms with an electronic filtering appliance.
